MEDICARE: CROSSROADS FOOT AND ANKLE PODIATRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	M100060875	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0311390001	OTHER	IN	DME
2	000000091947	OTHER	IN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275788499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS FOOT AND ANKLE PODIATRY PC

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-0548
Country	:	US
Telephone Number	:	574-223-6050
Fax Number	:	574-223-3057

Provider Business Practice Location Address
First Line	:	120 E 18TH ST
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-2632
Country	:	US
Telephone Number	:	574-223-6050
Fax Number	:	574-223-3057

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAURENCE C ROGERS
Credential	:	DPM
Telephone Number	:	574-223-6050

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	05/01/2012

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Directions to “CROSSROADS FOOT AND ANKLE PODIATRY PC ” Practice Location

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